Provider Demographics
NPI:1982637526
Name:BELCHER, MELISSA L (PT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:L
Last Name:BELCHER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:L
Other - Last Name:NUTTING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:100 FORE ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-4879
Mailing Address - Country:US
Mailing Address - Phone:207-773-5778
Mailing Address - Fax:207-773-5773
Practice Address - Street 1:100 FODEN RD, WEST
Practice Address - Street 2:SUITE 205
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-2327
Practice Address - Country:US
Practice Address - Phone:207-780-8860
Practice Address - Fax:207-780-8857
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT 2533225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
043623OtherANTHEM
7959330OtherAETNA
ME266790099Medicaid
ME266790099Medicaid